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Should we offer ventral rectopexy to patients with recurrent external rectal prolapse?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

For patients with rectal prolapse undergoing Ventral Rectopexy (VR), the impact of prior prolapse surgery on prolapse recurrence is not well described.

Purpose

The purpose of this study was to compare recurrence rates after VR in patients undergoing primary and repeat rectal prolapse repairs.

Design

This study is a prospective cohort study.

Methods

IRB-approved prospective data registry of consecutive patients undergoing VR for full-thickness external rectal prolapse between 2009 and 2015.

Main outcome measures

Rectal prolapse recurrence was defined as either external prolapse through the anal sphincters or symptomatic rectal mucosa prolapse warranting additional surgery. Preoperative and postoperative morbidity and functional outcomes were analyzed. Actuarial recurrence rates were calculated using the Kaplan-Meier method.

Results

A total of 108 VRs were performed during the study period. Seventy-two were primary and 36 repeat repairs. Seven cases were open, 23 laparoscopic, and 78 robotic. Six cases were converted from laparoscopic/robotic to open. In 63 patients, VR was combined with gynecological procedures. There were no statistical differences between primary or recurrent prolapse for the following: demographics, operative time, concomitant gynecologic procedures, complications, blood loss, and graft material type. Length of stay was longer in patients with a history of prior prolapse surgery (p = 0.01). Prolapse recurrence rates for primary repairs were reported at 1.4, 6.9, and 9.7% and for recurrent prolapse procedures 13.9, 25, and 25% at 1, 3, and 5 years (p = 0.13). Mean length of follow-up was similar between groups. Time to recurrence was significantly shorter in patients undergoing repeat prolapse surgery 8.8 vs 30.7 months (p = 0.03).

Conclusions

VR is a better option for patients undergoing primary rectal prolapse repair.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Brooke Gurland, Maria Emilia Carvalho e Carvalho, Tracy Hull & Massarat Zutshi

  2. Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Cleveland Clinic, Gynecology and Women’s Health Institute, Cleveland, OH, USA

    Beri Ridgeway & Marie Fidela R. Paraiso

Authors
  1. Brooke Gurland
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  2. Maria Emilia Carvalho e Carvalho
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  3. Beri Ridgeway
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  4. Marie Fidela R. Paraiso
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  5. Tracy Hull
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  6. Massarat Zutshi
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Contributions

BG: Concept, design, data analysis and interpretation, manuscript writing.

MEC: Data collection, data analysis.

BR: Data interpretation, manuscript editing.

MP: Data interpretation, manuscript editing.

TH: Data interpretation, manuscript editing.

MZ: Concept, design, data interpretation, manuscript editing.

Corresponding author

Correspondence to Brooke Gurland.

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Gurland, B., e Carvalho, M.E.C., Ridgeway, B. et al. Should we offer ventral rectopexy to patients with recurrent external rectal prolapse?. Int J Colorectal Dis 32, 1561–1567 (2017). https://doi.org/10.1007/s00384-017-2858-9

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  • DOI: https://doi.org/10.1007/s00384-017-2858-9

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